Prognostic factors for recurrence and complications in the surgical management of primary chordoid gliomas: A systematic review of literature

Abstract

Objective: Chordoid gliomas (CG) are rare neoplasms which frequently arise within the third ventricle. Surgery remains the mainstay treatment for CG. The present study comprehensively reviews all reported cases of CG within the literature in order to identify risk factors for surgical complications and tumor recurrence.

Methods: A comprehensive search on MEDLINE (OVID and PubMed), Scopus, Embase, and Web of Science was conducted following PRISMA guidelines to identify all reported cases of CG.

Results: A total of 81 patients met the study criteria which comprised of 33 males and 48 females. Median age at diagnosis was 48 years with a range from 5 to 72 years, and mean tumor size was 3.1cm. Biopsy, subtotal resection (STR), and gross total resection (GTR) were achieved in 8, 34, and 33 patients, respectively, with six cases not reporting extent of resection (EOR). Thirteen patients underwent adjuvant radiotherapy. Postoperative complications were noted in 30 cases (37%), with new onset diabetes insipidus being the most common. Postoperative morbidity was not associated with age, tumor size, or extent of resection. A trans-lamina terminalis approach demonstrated a strong trend towards decreased overall rates of postoperative morbidity compared to other approaches (p=0.051). GTR was associated with improved progression-free survival (PFS; p=0.028), while adjuvant radiotherapy, age, tumor size and proliferative index were not predictive of patient outcomes.

Conclusion: GTR should be the primary goal for the management of CG, as it is associated with improved rates of tumor control without an increased rate of postoperative complications. Surgical approach was a stronger predictor of complication rates than extent of resection. Morbidity remains high, and future studies to further elaborate on factors predictive of postoperative complications are critical.

Keywords: Chordoid; Diabetes insipidus; Glioma; Hypothalamic dysfunction; Radiosurgery.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)

Figure 2

Kaplan Meier analysis of recurrence free survival (PFS) based on extent of resection. STR: subtotal resection. GTR: gross total resection. There were no recurrences within the GTR group. 1-, 3-, and 5 year PFS for STR was 85.2%, 71.0%, and 35.5% respectively. GTR was associated with an improved rate of tumor control than STR and biopsy (p= 0.0276).